GOVERNMENT OF BIHAR

BIHAR COMBINED ENTRANCE COMPETITIVE EXAMINATION BOARD

Online Application Form for Bihar Combined Entrance Competitive Examination (BCECE) - 2024 for admission to
First Year Degree Courses.

Registration No.
Please do not send this Hard Copy to BCECE Board
2240021357
PART A
1. Name of Examination : BCECE-2024

2. Course Group Applied For : PCM (PHYSICS + CHEMISTRY + MATHS)

3. Candidate's Name : VISHAL KUMAR

4. Father's Name : RAKESH KUMAR GUPTA

5. Mother's Name : JULI DEVI

6. Date of Birth : 08 / AUGUST / 2004

7. Gender : MALE

8. Category : EBC (EXTREMELY BACKWARD CLASS)

9. Mobile No : 620****813

10. Email ID : COOLWITHVISHAL@GMAIL.COM

11. Aadhaar No : 729****945

12. Are you permanent resident of Note : Please Affix your same photo and put your full signature in
YES English and Hindi in space provided above
Bihar? :

13. Residential Eligibility :

14. Disabled Quota : NO

15. If you unable to write due to permanent loss of limbs / suffering from Cerebral palsy,
N/A
then do you claim for providing Scribe :

16. District Name of the Institute of passing/appearing at I.Sc or equivalent VAISHALI

17. Mark of Identification : A CUT CLOSE TO LEFT EYE

18. Is your Family (Father/Mother) annual income is less than 8 Lakhs : YES

19. Do you Claim for Service Men's Quota (SMQ) : NO

20. Are you Son / Unmarried Daughter of Ex-Servicemen / Retired / Serving Military
N/A
Personnel :

21. Do you claim for Self-Financed Scheme seat? : NO

22. Do you claim for NRI Quota? : NO

23. Educational Details :

% of
Board/ University Passing Passing Marks Total
Level School/ College Name marks /
Name Status Year Obtained Marks
CGPA

CENTRAL BOARD
PARK MOUNT PUBLIC
SECONDARY/STANDARD X OF SECONDARY PASSED 2020 392 500 78.40%
SCHOOL
EDUCATION

SANT KABIR MAHANT BIHAR SCHOOL

I.SC/XII (10+2) RAMDYAL DAS EXAMINATION PASSED 2022 219 400 54.75%
MAHAVIDYALAYA BOARD

Registration No: 2240021357 Page: 1/6

 24. Subject Details :

% of Marks
Marks Total % of Marks % of Marks % of Marks Obtained in
Name of Subject Obtained in
Obtained Marks Obtained in PCM Obtained in PCB CBA/PCA/MBA/MCA
English

ENGLISH 66 100

PHYSICS 60 100
66.00 % 51.00 % N/A N/A
CHEMISTRY 59 100

MATHS 34 100

25. Payment Details :

Payment Mode Journal No./Transaction No. Deposit Date Amount (in Rs.)

UPI ZIC51969997576 07/05/2024 02:20 PM Rs.ONE THOUSAND ONLY

26. Address Details

A. Permanent Address: B. Correspondence Address:

EAST INDIRA NAGAR EAST INDIRA NAGAR
ROAD NO.4 ROAD NO.4
KANKARBAGH KANKARBAGH
District: PATNA District: PATNA
State: BIHAR State: BIHAR
Pin Code: 800020 Pin Code: 800020

27. Declaration by the Candidate :

I VISHAL KUMAR declare that the informations furnished above are correct and I shall forfeit my candidature and will be liable for legal action in case
of any of them is proved to be false at any stage inclusive of admission or thereafter.

Date : .......................

Place : ...................... (Signature in English) (Signature in Hindi)

Registration No: 2240021357 Page: 2/6

 GOVERNMENT OF BIHAR
BIHAR COMBINED ENTRANCE COMPETITIVE EXAMINATION BOARD
Online Application Form for Bihar Combined Entrance Competitive Examination (BCECE) - 2024 for admission to
First Year Degree Courses.

Registration No.
Please do not send this Hard Copy to BCECE Board
2240021357
PART B
(For Office use only)
Selected for admission (1st Counselling) Selected for admission (2nd Counselling) Selected for admission (Mop-Up Counselling)
Against Roll No........................................... Against Roll No........................................... Against Roll No...........................................
Category.......................................................... Category.......................................................... Category..........................................................
Merit Serial....................................................... Merit Serial....................................................... Merit Serial.......................................................
at...................................................(institution) at...................................................(institution) at...................................................(institution)
in...................................................(Course/Branch) in...................................................(Course/Branch) in...................................................(Course/Branch)

...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ......................

Signature of Signature of Controller of Signature of Signature of Controller of Signature of Signature of Controller of
the the verifying Examination the the verifying Examination the the verifying Examination
Candidate Officer BCECEB Candidate Officer BCECEB Candidate Officer BCECEB
(At the time of BCECE-2024 (At the time of BCECE-2024 (At the time of BCECE-2024
Counselling) Counselling) Counselling)

Date : ....................................... Date : ....................................... Date : .......................................

1. Name of Examination : BCECE-2024

2. Course Group Applied For : PCM (PHYSICS + CHEMISTRY + MATHS)

3. Candidate's Name : VISHAL KUMAR

4. Father's Name : RAKESH KUMAR GUPTA

5. Mother's Name : JULI DEVI

6. Date of Birth : 08 / AUGUST / 2004

7. Gender : MALE

8. Category : EBC (EXTREMELY BACKWARD CLASS)

9. Mobile No : 620****813

10. Email ID : COOLWITHVISHAL@GMAIL.COM

11. Aadhaar No : 729****945

12. Are you permanent resident of Note : Please Affix your same photo and put your full signature in
YES English and Hindi in space provided above
Bihar? :

13. Residential Eligibility :

14. Disabled Quota : NO

15. If you unable to write due to permanent loss of limbs / suffering from Cerebral palsy,
N/A
then do you claim for providing Scribe :

Registration No: 2240021357 Page: 3/6

16. District Name of the Institute of passing/appearing at I.Sc or equivalent VAISHALI

17. Mark of Identification : A CUT CLOSE TO LEFT EYE

18. Is your Family (Father/Mother) annual income is less than 8 Lakhs : YES

19. Do you Claim for Service Men's Quota (SMQ) : NO

20. Are you Son / Unmarried Daughter of Ex-Servicemen / Retired / Serving Military
N/A
Personnel :

21. Do you claim for Self-Financed Scheme seat? : NO

22. Do you claim for NRI Quota? : NO

23. Educational Details :

% of
Board/ University Passing Passing Marks Total
Level School/ College Name marks /
Name Status Year Obtained Marks
CGPA

CENTRAL BOARD
PARK MOUNT PUBLIC
SECONDARY/STANDARD X OF SECONDARY PASSED 2020 392 500 78.40%
SCHOOL
EDUCATION

SANT KABIR MAHANT BIHAR SCHOOL

I.SC/XII (10+2) RAMDYAL DAS EXAMINATION PASSED 2022 219 400 54.75%
MAHAVIDYALAYA BOARD

24. Subject Details :

% of Marks
Marks Total % of Marks % of Marks % of Marks Obtained in
Name of Subject Obtained in
Obtained Marks Obtained in PCM Obtained in PCB CBA/PCA/MBA/MCA
English

ENGLISH 66 100

PHYSICS 60 100
66.00 % 51.00 % N/A N/A
CHEMISTRY 59 100

MATHS 34 100

25. Payment Details :

Payment Mode Journal No./Transaction No. Deposit Date Amount (in Rs.)

UPI ZIC51969997576 07/05/2024 02:20 PM Rs.ONE THOUSAND ONLY

26. Address Details

A. Permanent Address: B. Correspondence Address:

EAST INDIRA NAGAR EAST INDIRA NAGAR
ROAD NO.4 ROAD NO.4
KANKARBAGH KANKARBAGH
District: PATNA District: PATNA
State: BIHAR State: BIHAR
Pin Code: 800020 Pin Code: 800020

Registration No: 2240021357 Page: 4/6

 27. Declaration of Candidate :

I VISHAL KUMAR Son/Daughter of RAKESH KUMAR GUPTA hereby solemnly and sincerely affirm the statements made and information furnished
above by me and in the enclosures hereby submitted by me are true and correct. I have not kept my information secret. If, however, it is found that
any information furnished therein is fraudulent, incorrect or untrue in materials/particulars, I realize that I am liable criminal prosecution and agree to
forego my seat in the college and further that the selection and admission to this course is liable to be canceled. I agree to abide by the rules and
regulations governing this Examination and as contained in the prospectus of BCECE - 2024

Repeat below in your handwriting (not in capital letters) the above mentioned Declaration and put your signature in English and Hindi at
the specified spaces as signed in Part A of the Online Application Form. If you fail to do so, your Candidature shall be rejected:

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

.........................................................................................................................................................................................................................................

Date : .............................. (Signature in English) ......................................................................

Place : .............................. (Signature in Hindi) ..........................................................................

Counter Signature of Father/Mother/Husband/Guardian : .......................................................

28. List of enclosures :

1. .................................................................................... 2. ....................................................................................

3. .................................................................................... 4. ....................................................................................

5. .................................................................................... 6. ....................................................................................

7. .................................................................................... 8. ....................................................................................

Registration No: 2240021357 Page: 5/6

29.
(AT THE TIME OF FIRST COUNSELLING/INTERVIEW ONLY)

(II.) L.T.I. of the Candidate

(English) ........................
(I.) Full Signature of Candidate
(Hindi) ...........................

(AT THE TIME OF SECOND COUNSELLING/INTERVIEW ONLY)

(II.) L.T.I. of the Candidate

(English) ........................
(I.) Full Signature of Candidate
(Hindi) ...........................

(AT THE TIME OF MOP-UP COUNSELLING/INTERVIEW ONLY)

(II.) L.T.I. of the Candidate

(English) ........................
(I.) Full Signature of Candidate
(Hindi) ...........................

30.
FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF FIRST COUNSELLING

Roll No. .............................................. Category .............................................. Merit Serial .............................................. of BCECE - 2024 in the First

Year of .............................................. Course/Branch of the Institute .............................................. as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE DIRECTOR / PRINCIPAL

FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF SECOND COUNSELLING

Roll No. .............................................. Category .............................................. Merit Serial .............................................. of BCECE - 2024 in the First

Year of .............................................. Course/Branch of the Institute .............................................. as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE DIRECTOR / PRINCIPAL

FOR OFFICE USE OF THE CONCERNED INSTITUTE ON THE BASIS OF MOP-UP COUNSELLING

Roll No. .............................................. Category .............................................. Merit Serial .............................................. of BCECE - 2024 in the First

Year of .............................................. Course/Branch of the Institute .............................................. as He/She fulfilled all the requirements of being

admitted.

SEAL OF THE INSTITUTE SIGNATURE OF THE DIRECTOR / PRINCIPAL

Registration No: 2240021357 Page: 6/6